Fibromyalgia (FM) syndrome is characterized by widespread pain that is exacerbated by cold and stress but relieved by warmth. We review the points along thermal and pain pathways where temperature may influence pain. We also present evidence addressing the possibility that brown adipose tissue activity is linked to the pain of FM given that cold initiates thermogenesis in brown adipose tissue through adrenergic activity, whereas warmth suspends thermogenesis.

Although females have a higher incidence of FM and more resting thermogenesis, they are less able to recruit brown adipose tissue in response to chronic stress than males. In addition, conditions that are frequently comorbid with FM compromise brown adipose activity making it less responsive to sympathetic stimulation. This results in lower body temperatures, lower metabolic rates, and lower circulating cortisol/corticosterone in response to stress-characteristics of FM.

In the periphery, sympathetic nerves to brown adipose also project to surrounding tissues, including tender points characterizing FM. As a result, the musculoskeletal hyperalgesia associated with conditions such as FM may result from referred pain in the adjacent muscle and skin.

" As a result, the musculoskeletal hyperalgesia associated with conditions such as FM may result from referred pain in the adjacent muscle and skin."

For me, I require a plausible explanation of the suggesttion of referred pain.

Many people with FM do not worsen with the cold and some people with FM are quite intolerant of higher temperatures found in the semi and tropical countries. Also we have found that some people with FM cannot tolerate thermal pools used for arthritic paliative treatments.

Overall I am doubtful of this hypothesis as a significant factor in FM.

I, too, have doubts about this study. I think the premise upon which the study is based – that FM "is characterized by widespread pain that is exacerbated by cold...but relieved by warmth" – is flawed.

While most FM patients do seem to be sensitive to cold, some (like myself) feel best when it is cold and are hyper-sensitive to heat. Therefore, this hypothesis is not applicable to all FM patients.